After finding thyroid nodules, patients should examine the thyroid gland and its adjacent cervical lymph nodes in detail, such as head and neck radiation exposure caused by bone marrow transplantation, family history of thyroid cancer in first-degree relatives, rapid growth of masses, hoarseness and so on, all of which suggest that the nodules are malignant. The results of vocal cord paralysis, enlarged neck lymph nodes on the same side of the nodule and relative fixation with surrounding tissues also suggest that the nodule may be malignant.
When the diameter of thyroid nodule is >: 65438±0cm, the serum TSH level should be checked. If TSH is low, a radionuclide thyroid scan should be performed to determine whether the nodule is functional, functionally equivalent ("warm nodule") or nonfunctional. Functional nodules are rarely malignant, so it is not necessary to make cytological evaluation of such nodules. If serum TSH is not inhibited, diagnostic thyroid ultrasound examination should be performed, which is helpful to determine whether there are nodules consistent with palpable lesions, whether the cystic part of nodules is >: 50%, and whether the nodules are located behind the thyroid gland. The latter two conditions will reduce the accuracy (FNA) of fine needle aspiration biopsy. FNA is recommended even if TSH is elevated, because the malignant rate of nodules in normal thyroid tissue is similar to Hashimoto's thyroiditis. Serum thyroglobulin (TG) level will increase in most thyroid diseases, and it is neither sensitive nor specific to thyroid cancer. Serum calcitonin is a meaningful index. Routine detection of serum calcitonin can early detect parathyroid cell hyperplasia and medullary thyroid carcinoma, thus improving the overall survival rate of such patients. Without stimulation, serum calcitonin >: 100 pg/ml suggests that medullary thyroid carcinoma may exist.
The malignant risk of multiple thyroid nodules is the same as that of single nodules. Ultrasound examination should be performed to determine the morphology of multiple nodules. If needle aspiration biopsy is only performed on the largest nodule, thyroid cancer may be missed. If ultrasound shows microcalcification, low echo and abundant blood supply between nodules, it suggests that nodules may be malignant. Even if thyroid nodules are diagnosed as benign, patients should be followed up because the false negative rate of FNA can reach 5%. Although these patients are few, they can't be ignored. The diameter of benign nodules will be smaller and smaller, while the diameter of malignant nodules will increase, although the rate of increase is very slow.
Considering your specific situation, your right lobe nodules are mostly benign, accompanied by liquefaction and necrosis. We can continue to observe Surgical treatment is feasible if you are afraid of malignant transformation or the nodules are prone to malignant transformation during regular review. Surgery should remove the right lobe and isthmus. If hypothyroidism occurs after operation, thyroid hormone replacement therapy can be taken. Taking medicine on an empty stomach every morning has little effect on life. Don't worry.